Increased self-reported and objectively assessed physical activity predict sleep quality among adolescents

Anxiety, Sleep Problems, and Vigorous Physical Activity: Bidirectional Associations from Early Adolescence to Early Adulthood in Swedish Adolescents

Anxiety symptoms and sleep problems typically emerge during adolescence and are frequently intertwined. However, there is a dearth of knowledge concerning their reciprocal influence and whether physical activity might play a protective role in this relationship. The present study aims at filling this gap exploring also the moderating role of sex. 915 13-year-old Swedish adolescents (56% girls) answered a survey conducted four times: at ages 13 (T1), 16 (T2), 19 (T3), and 22 (T4). A random intercept cross-lagged panel model was used. At within-levels, sleep problems and anxiety symptoms had a bidirectional positive association in middle adolescence. Vigorous physical activity and anxiety symptoms showed a reciprocal negative association from middle adolescence. Vigorous physical activity and sleep problems were reciprocally associated only in late adolescence. Associations were the same for girls and boys. This study demonstrated that the relations between anxiety symptoms, sleep problems, and vigorous physical activity cannot be understood without adopting a developmental perspective and that middle adolescence is a crucial period to plan interventions to reduce anxiety symptoms and sleep problems.

Sleep and Activity Patterns in Autism Spectrum Disorder

Background

Autism spectrum disorder (ASD) is a highly heritable and heterogeneous neurodevelopmental disorder characterized by impaired social interactions, repetitive behaviors, and a wide range of comorbidities. Between 44-83% of autistic individuals report sleep disturbances, which may share an underlying neurodevelopmental basis with ASD.

Methods

We recruited 382 ASD individuals and 223 of their family members to obtain quantitative ASD-related traits and wearable device-based accelerometer data spanning three consecutive weeks. An unbiased approach identifying traits associated with ASD was achieved by applying the elastic net machine learning algorithm with five-fold cross-validation on 6,878 days of data. The relationship between sleep and physical activity traits was examined through linear mixed-effects regressions using each night of data.

Results

This analysis yielded 59 out of 242 actimetry measures associated with ASD status in the training set, which were validated in a test set (AUC: 0.777). For several of these traits (e.g. total light physical activity), the day-to-day variability, in addition to the mean, was associated with ASD. Individuals with ASD were found to have a stronger correlation between physical activity and sleep, where less physical activity decreased their sleep more significantly than that of their non-ASD relatives.

Conclusions

The average duration of sleep/physical activity and the variation in the average duration of sleep/physical activity strongly predict ASD status. Physical activity measures were correlated with sleep quality, traits, and regularity, with ASD individuals having stronger correlations. Interventional studies are warranted to investigate whether improvements in both sleep and increased physical activity may improve the core symptoms of ASD.

Frequency of Vigorous physical activity and sleep difficulty in adolescents: A multiply-country cross-sectional study

BACKGROUND

Sleep is an essential health behavior, and sleep difficulties are strongly associated with adolescent health, potentially leading to more severe sleep disorders. The beneficial effects of physical activity (PA) in alleviating sleep difficulties have been well-documented. Numerous investigations reveal influence in moderate to high-intensity physical activity (PA) positively influences sleep quality. Despite these findings, a gap in the literature exists, particularly regarding the association between frequency of vigorous-intensity physical activity (VPA) and sleep difficulties.

AIM

This study aims to bridge the knowledge gap by exploring the link between sleep difficulty and frequency of VPA among adolescents. Insights are derived from analyzing data accumulated from the Health Behavior in School-aged Children (HBSC) project.

METHODS

The analysis in this study utilized cross-sectional data from the HBSC (2017/2018). The study sample comprised a total of 171,233 respondents aged 11, 13, and 15 years, with males representing 51.1% of sample. Measurement instruments included a self-administered questionnaire, providing direct insight into sleep difficulty and frequency of VPA levels. Statistical analysis on the associaiton between frequency of VPA and sleep difficulties was conducted using Generalized Linear Models.

RESULTS

50.0% of adolescents reported no sleep difficulties, while 12.3% experienced sleep issues daily. Additionally, 17.1% of adolescents engaged in frequency of VPA on a daily basis, while 6.4% never participated in such activities. daily VPA was associated with fewer sleep difficulties (OR = 1.07 [1.00, 1.15]), 4-6 times a week (OR = 1.08 [1.01, 1.15]), and 2-3 times a week (OR = 1.08 [1.02, 1.16]). However, no significant association was found between sleep difficulties and frequency of VPA in girls. Furthermore, a negative association was observed between sleep difficulties and all frequencies of VPA (p < 0.05) in 11-year-old adolescents. For 13-year-olds, daily VPA was significantly associated with fewer sleep difficulties (OR = 1.10 [1.02, 1.19]), 4-6 times a week (OR = 1.15 [1.07, 1.24]), 2-3 times a week (OR = 1.19 [1.10, 1.27]), and once a week (OR = 1.13 [1.05, 1.22]). However, no significant association was found between sleep difficulties and frequency of VPA in 15-year-old adolescents.

CONCLUSION

More participations in VPA would be an effective approach to reduce sleep difficulties in adolescents. Insights gleaned from this research illustrate a discernible link between sleep difficulty and frequency of VPA, particularly notable in male and 13-year-old participants. It is also imperative to underscore the variability in the connection between sleep difficulty and frequency of VPA, distinctly influenced by factors such as gender and age. Consequently, tailoring sleep intervention methodologies to align with the specific needs dictated by these variables emerges as a pivotal recommendation.

Can an intervention integrating sports and medicine improve children's health more effectively? Monitoring based on sleep, body mass index, and heart rate variability

Background

Theoretical studies have suggested that the integration of sports and medicine with one another could positively affect children's health. By monitoring the variation characteristics of children's sleep, body mass index (BMI), and heart rate variability (HRV), we explored and compared the influences of and differences between two interventions - physical exercise and an intervention integrating sports and medicine - on improving children's health.

Methods

We conducted a randomised controlled study, where we randomly divided 136 children into the physical exercise group (PEG), the integration of sports and medicine group (ISMG), and the control group. We measured sleep, BMI, and HRV at baseline and week eight.

Results

After the eight-week intervention, the sleep scores in the PEG and the ISMG were significantly lower than in the control group, while the scores in the ISMG were significantly lower than in the PEG. After the eight-week intervention, the BMI of both the PEG and the ISMG was significantly lower than that of the control group, without a significand difference between the two intervention groups. After the eight-week intervention, the standard deviation of normal-to-normal intervals (SDNN), root mean square differences of the standard deviation (RMSSD), low-frequency of normal (LFn), and high-frequency of normal (HFn) in the PEG and the ISMG were significantly higher than those in the control group, again without a significant difference between the two intervention groups. After intervention, sleep, BMI, and HRV of the three groups were correlated with one another to different degrees, but the correlation coefficient of the two exercise groups was higher.

Conclusions

Based on the interventions, we observed a significant correlation between sleep, BMI, and HRV in children. Regular physical exercise or an intervention integrating sports and medicine could synergistically improve sleep, BMI, and HRV in this population, with the latter having a better effect on improving sleep quality.

Path of Physical Exercise's Impact on Deviant Behavior Among Chinese Adolescents

Purpose

Physical exercise is an important predictor of deviant behavior in adolescents; however, the paths and mechanisms underlying this relationship remain understudied.

Patients and Methods

This cross-sectional study used education tracking data of 8725 Chinese adolescents (4453 males, 4240 females, average age 14 ± 0.73) to construct a chain mediation model to explore whether sleep quality and mental health mediated the relationship between physical exercise and adolescent deviant behavior.

Results

The results show that physical exercise cannot directly predict adolescent deviant behavior; however, it can indirectly affect deviant behavior through the mediating effect of sleep quality and mental health as well as the chain mediating benefit of "sleep quality-mental health".

Conclusion

Sleep quality and mental health are important internal factors of physical exercise that inhibit deviant adolescent behavior. The lack of physical activity and poor sleep quality should be prioritized in interventions regarding deviant behavior among Chinese adolescents.

The efficacy of physical exercise interventions on mental health, cognitive function, and ADHD symptoms in children and adolescents with ADHD: an umbrella review

Background

A considerable number of published reviews have addressed the effects of physical exercise on mental health, cognitive function, or attention-deficit hyperactivity (ADHD) symptoms as outcomes in children and adolescents with ADHD. Their findings have often conflicted, therefore, there is an urgent need to synthesise a hierarchy of the evidence and examine the credibility of previous meta-analyses. To establish the robustness of these findings, we conducted an additional meta-analysis on a number of individual studies that were not covered in previous reviews but were suitable for inclusion in our own study.

Methods

Three reviewers independently searched Web of Science, Psych INFO, Embase, Cochrane Library, PubMed, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for meta-analyses published between database inceptions to December 1, 2022. The individual studies were also screened from 1 January 2015 to 1 December 2022. We included meta-analyses and eligible individual studies that addressed the effects of exercise on at least one outcome of mental health, cognitive function, or ADHD symptoms in children and adolescents with ADHD. We excluded systematic reviews and articles that lacked sufficient data for a meaningful second analysis. The effect estimates (Hedges' g), 95% confidence interval (95% CI), 95% prediction interval (95% PI), small study effects, and excess significance bias were calculated. Finally, we categorised the meta-analyses based on the credibility of the evidence criteria and their quality using a Measurement Tool to Assess Systematic Reviews 2 checklist. This umbrella review was registered with PROSPERO, CRD42022361331.

Findings

Of 181 listed review articles and 60 individual papers, 10 reviews and 12 individual articles were included in the meta-analyses. This yielded 37 meta-analyses based on 106 study estimates. Evidence was highly suggestive for the effectiveness of exercise (class II) for improving inattention (G = 0.92, 95% CI: 0.44-1.39, 95%), inhibitory control (G = 0.82, 95% CI: 0.52-1.13), and cognitive flexibility (G = 0.52, 95% CI: 0.32-0.72). However, evidence for the effectiveness of exercise on emotional, social, and working memory outcomes was weak, and these results were not significant for hyperactivity and behavioural functioning.

Interpretation

Improvement of cognitive flexibility, inhibitory control, and inattention in children and adolescents with ADHD was highly suggested by exercise interventions. However, results were weak for other outcomes (emotional functioning, social functioning, and working memory). Further high-quality randomised controlled trials are, therefore, warranted to determine the effectiveness of exercise on weak outcomes.

Funding

None.

Better sleep quality and higher physical activity levels predict lower emotion dysregulation among persons with major depression disorder

BACKGROUND

People with Major Depression Disorders (MDD) often complain about sleep problems and experience emotion dysregulation. Prior research suggests physical activity can improve both sleep quality and emotional control. However, there is limited research on emotion regulation and the impact of physical activity and sleep in this population.

OBJECTIVES

The present study examined the relationships between sleep quality, emotion regulation, and physical activity levels among patients with MDD.

METHODS

The sample consisted of 118 patients with MDD (mean age: 31.85 years) who completed questionnaires on sleep quality, physical activity, emotion regulation, and depression.

RESULTS

Results showed that more sleep problems were associated with worse emotion dysregulation, and more physical activity was associated with fewer sleep problems and less emotion dysregulation. Furthermore, physical activity and sleep quality significantly predicted emotion dysregulation, with physical activity being the stronger predictor.

CONCLUSIONS

Results from this study suggest that individuals with MDD who are able to engage in physical activity and get better sleep could experience emotional regulation benefits.

Adolescents' Out-of-School Physical Activity Levels and Well-Being during the COVID-19 Restrictions in Greece: A Longitudinal Study

The present study aimed to identify the impact of social distancing measures on adolescents' physical activity (PA) levels and well-being during the implementation of COVID-19 restrictive measures. There were 438 participants (207 boys and 231 girls), aged 12 to 15 years old (M = 13.5, SD = 0.55). They completed online questionnaires on well-being and PA in three waves (December 2020, February 2021, and June 2021). Correlation analyses were conducted to examine the relationship between well-being and PA variables in the three measurements. Additionally, separate three-way repeated-measures ANOVAs were conducted to capture possible differences in students' moderate to vigorous physical activity (MVPA) levels, life satisfaction, and subjective vitality among the three measurements due to gender, age, and interaction between gender and age. A significant relation emerged between the MVPA variables and well-being. In all measurements, adolescents' PA levels did not meet the World Health Organization (WHO) recommendations of at least 60 min per day in MVPA. Students' MVPA levels, life satisfaction, and subjective vitality were significantly higher in the third measurement compared to the first and second ones. Moreover, significant differences emerged in life satisfaction and subjective vitality between boys and girls in the first and third measurements, respectively. The COVID-19 restrictions appeared to negatively influence adolescents' PA and well-being. Policymakers aimed at facilitating adolescents' well-being in a similar situation in the future should not adopt measures restricting the participation of adolescents in PA.

Neurobiological, Psychosocial, and Behavioral Mechanisms Mediating Associations Between Physical Activity and Psychiatric Symptoms in Youth in the Netherlands

Importance

Understanding the mechanisms by which physical activity is associated with a lower risk of psychiatric symptoms may stimulate the identification of cost-efficient strategies for preventing and treating mental illness at early life stages.

Objective

To examine neurobiological, psychosocial, and behavioral mechanisms that mediate associations of physical activity with psychiatric symptoms in youth by testing an integrated model.

Design, setting, and participants

Generation R is an ongoing prospective population-based cohort study collecting data from fetal life until young adulthood in a multiethnic urban population in the Netherlands. Pregnant women living in Rotterdam with an expected delivery date between April 2002 and January 2006 were eligible for participation along with their children born during this time. Data were collected at a single research center in the Erasmus Medical Center Sophia Children's Hospital. For the current study, data were analyzed from 4216 children with complete data on both exposure and outcome at ages 6, 10, and 13 years. Data were analyzed from January 2021 to November 2022.

Exposures

Physical activity was ascertained at age 6 years (visit 1) via parent report and included weekly frequency and duration of walking or cycling to or from school, physical education at school, outdoor play, swimming, and sports participation.

Main Outcomes and Measures

Psychiatric symptoms (internalizing and externalizing symptoms) were assessed at age 6 years (visit 1) and at age 13 years (visit 3) using the Child Behavior Checklist. Several mechanisms were explored as mediators, measured at age 10 years (visit 2). Neurobiological mechanisms included total brain volume, white matter microstructure, and resting-state connectivity assessed using a 3-T magnetic resonance imaging scanner. Psychosocial mechanisms included self-esteem, body image, and friendship. Behavioral mechanisms included sleep quality, diet quality, and recreational screen time. Pearson correlations between physical activity measures and psychiatric symptoms were calculated, with false discovery rate correction applied to account for the number of tests performed. Mediation analyses were performed when a correlation (defined as false discovery rate P < .05) between exposure and outcome was observed and were adjusted for confounders.

Results

Among the 4216 children included in this study, the mean (SD) age was 6.0 (0.4) years at visit 1, and 2115 participants (50.2%) were girls. More sports participation was associated with fewer internalizing symptoms (β for direct effect, -0.025; SE, 0.078; P = .03) but not externalizing symptoms. Self-esteem mediated the association between sports participation and internalizing symptoms (β for indirect effect, -0.009; SE, 0.018; P = .002). No evidence was found for associations between any other neurobiological, psychosocial, or behavioral variables. No association was found between other types of physical activity and psychiatric symptoms at these ages.

Conclusions and Relevance

The integrated model presented in this cohort study evaluated potential mechanisms mediating associations between physical activity and psychiatric symptoms in youth. Self-esteem mediated an association between sports participation in childhood and internalizing symptoms in adolescence; other significant mediations were not observed. Further studies might explore whether larger effects are present in certain subgroups (eg, children at high risk of developing psychiatric symptoms), different ages, or structured sport-based physical activity interventions.

Chronotype and quality of sleep in alpine skiers

Alpine skiing is among the most demanding sporting activities in terms of physical effort and mental workload. The aim of the study was to compare sleep quality and chronotype distribution between 84 highly trained alpine skiers and a control sample of 84 non-athletes matched by age and sex ratio. Quality of sleep was assessed by the Pittsburgh Quality of Sleep Index (PSQI), and chronotype was assessed by the Morningness-Eveningness Questionnaire (MEQ). Additional questions assessed sleep management during training or competitions. The results showed a marked skewed chronotype distribution towards morningness in alpine skiers (52.4% morning type, 42.8% intermediate, and 4.8% evening type) in comparison to the control group. The midpoint of sleep was significantly anticipated among alpine skiers. Differently from the previous literature that showed poor sleep quality and quantity in competitive athletes, the quality and quantity of sleep in alpine skiers was within the normal range in all the PSQI subcomponents.

"What If Others Think I Look Like…" The Moderating Role of Social Physique Anxiety and Sex in the Relationship between Physical Activity and Life Satisfaction in Swiss Adolescents

BACKGROUND

Physical activity has been shown to have a positive effect on life satisfaction in adolescents. Despite these benefits, physical activity levels constantly drop during adolescence, suggesting potential interfering factors in this link. Since worries about physical appearance are an important issue at this age, this study aims to examine the relationship between physical activity and life satisfaction in adolescents and explores possible moderating effects of social physique anxiety and sex.

METHODS

We used data from a longitudinal study with N = 864 vocational students (mean age = 17.87 years, range: 16-25, 43% female) from Switzerland. To test our hypotheses, we used multiple hierarchical regression analyses as well as simple slope analyses.

RESULTS

We did not find a significant direct effect of physical activity on life satisfaction. However, we found a significant two-way interaction between physical activity and social physique anxiety. An additional significant three-way interaction occurred, indicating that a positive effect of physical activity on life satisfaction holds only for female adolescents with low social physique anxiety levels.

CONCLUSIONS

This study highlights the importance of developing a healthy relationship with one's body to fully benefit from physical activity, especially for female adolescents. Taken together, these results reveal important considerations for physical activity educators.

Accelerometer-measured physical activity, sedentary behavior, and sleep in children with cerebral palsy and their adherence to the 24-hour activity guidelines

AIM

To measure and describe the 24-hour activities (i.e. physical activity, sedentary behavior, and sleep) and to examine adherence to the 24-hour activity guidelines among children with cerebral palsy (CP) using actigraphy.

METHOD

Children's 24-hour activities were recorded over 7 days using hip- and wrist-worn ActiGraph wGT3X-BT accelerometers.

RESULTS

In total, 362 days and 340 nights from 54 children with CP (Gross Motor Function Classification System [GMFCS] levels I-III; 44% females; median age [range] 6 years 6 months [3-12 years]) were included. Mean (SD) daily wear time was 746.2 (48.9) minutes, of which children spent on average 33.8% in light physical activity (251.6 [58.7] minutes per day), 5.2% in moderate-to-vigorous physical activity (38.5 [20.1] minutes per day), and the remaining 61.1% being sedentary (456.1 [80.4] minutes per day). Physical activity decreased while sedentary behavior increased with increasing GMFCS level. In total, 13% of all children met the physical activity recommendations, and 35% met the age-appropriate sleep duration recommendation. The proportion of children meeting the combined 24-hour guidelines for physical activity and sleep was low (5.9%), especially in those classified in GMFCS level III (0%).

INTERPRETATION

The observed low 24-hour guideline adherence rates emphasize the importance of considering the entire continuum of movement behaviors in the care of children with CP, in efforts to promote healthy lifestyle behaviors and prevent negative health outcomes.

Fatigue in transportation operations: A contextual factors survey among Iranian suburban drivers

BACKGROUND

Fatigue, as a persistent and serious occupational hazard, plays an important role in traffic accidents by reducing the driver's ability to maneuver with the vehicle and increasing the likelihood of falling asleep at the wheel.

OBJECTIVE

The purpose of this study was to identify the individual contextual factors, sleep condition, lifestyle, job characteristics, environmental, and economic conditions that affect the fatigue and alertness of Iranian suburban bus drivers.

METHODS

A questionnaire-based cross-sectional survey was used for this study. Non-probability sampling was used to study 401 suburban bus drivers from Tehran province, Iran, ranging in age from 24 to 67 years. The SPSS22 statistical software V27 was used for the analysis.

RESULTS

Approximately half of the participants (50.5%) had experienced fatigue while driving in the previous six months. According to a logistic regression analysis, the contextual factors were all independently related to falling asleep and fatigue while driving.

CONCLUSION

This study provides a thorough understanding of the contextual factors related to drowsy driving and emphasizes the importance of taking these things into consideration when developing interventions aimed at improving the driver's wellbeing and health and lowering the risk of errors and accidents.

Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS

BACKGROUND AND OBJECTIVE

Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents.

METHODS

Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs.

RESULTS

Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16-1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15-1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep.

CONCLUSION

This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.

Influence of naps on sedentary time and physical activity in early childhood

The objective was to determine if, in preschool-aged children, (1) nap habituality is associated with sedentary time and physical activity (movement behaviors), (2) nap physiology is associated with movement behaviors, and (3) if missing a nap, compared to taking a nap, affects movement behaviors on the same day and subsequent day. A within-subjects (44 children; 4.2 ± 0.6 years; 55.6% female), at-home study examined two experimental conditions (one afternoon each of nap- and wake-promotion with order counterbalanced) one week apart. Movement behaviors were derived from wrist-worn actigraphy (12.1 ± 3.1 days). Average movement behaviors were calculated from the overall study period with experimental days excluded. Movement behaviors were also extracted for the same day and the subsequent day of the two experimental conditions. Polysomnography was recorded during the nap-promoted condition. Children were classified as non-, intermediate-, or habitual-nappers. Although average movement behaviors were different between nap habituality groups, differences were not significant. There were no associations between movement behaviors and nap sleep stages, and no effects for nap condition or condition by nap habituality on same or next day movement behaviors. Findings do not suggest that naps and movement behaviors are related in children. Although a single missed nap was not detrimental to same or next day movement behaviors, future studies should explore effects of multiple days of subsequent nap restriction to examine potential cumulative effects.

Association between Physical Activity, Sedentary Behavior, Satisfaction with Sleep Fatigue Recovery and Smartphone Dependency among Korean Adolescents: An Age- and Gender-Matched Study

The purpose of this study was to identify the association between physical activity (PA), sedentary behavior (SB), satisfaction with sleep fatigue recovery (SSFR), and smartphone dependency in South Korean adults. We analyzed data from the National Health and Nutrition Examination Survey 2020 data. We selected participants who answered Internet addiction-related questions as “Very much” (n = 241) and answered Internet addiction-related questions as “Not at all” (n = 241) in the questionnaire. The participants were matched by age and gender, then divided into two groups. Between the two groups, there were considerable differences in the number of days participating in moderate to vigorous PA (5 days or more, p = 0.01), the number of strength training days (1 day, p = 0.02), the number of light PA days for more than 60 min (every day for the last 7 days, p = 0.01), and the SSFR over the past 7 days (p < 0.05). Additionally, the mean smartphone usage time and mean sedentary behavior time between the two groups showed significant differences. The study demonstrated that there were significant associations between PA, SB, SSFR, and smartphone dependency among Korean adolescents matched by age and gender. Additionally, this study highlights the importance of increasing overall PA and number of days participating in MVPA, decreasing SB time and smartphone usage time could reduce the incidence of smartphone overdependence.

Comparison of the Associations between Self-Reported Sleep Quality and Sleep Duration Concerning the Risk of Depression: A Nationwide Population-Based Study in Indonesia

There is substantial evidence that a lack of sleep quality and duration can increase the risk of depression in adults. Still, few studies have compared sleep quality and duration to the risk of depression in Indonesia. Therefore, this study aimed to compare the prevalence and risk of depression associated with both sleep quality and duration and identified those factors associated with sleep quality with sleep duration. This study was a cross-sectional study, and the data were obtained from the 2014 Indonesian Family Life Survey, with a total sample comprised of 19,675 respondents aged older than 15 years old. A self-reported questionnaire was used to assess sleep quality and duration. Depression was assessed using the Center for Epidemiologic Studies Depression (CESD-10) questionnaire. Logistic regression was used to examine the risk of depression, and multinomial logistic regression was used to examine the risk of poor sleep quality with consideration to sleep duration. The prevalence of depression was the highest in the poor sleep quality and long sleep duration groups (48.5%). After all variables associated with depression were adjusted, poor sleep quality was identified as a factor leading to a higher risk of depression (OR = 4.2; 95% CI: 3.7-4.6; p < 0.001) than long sleep duration (OR = 1.4; 95% CI: 1.2-1.6; p < 0.001). Furthermore, the interaction between poor sleep quality and long sleep duration gave the highest risk of depression (OR = 4.4; 95% CI: 3.6-5.3); p < 0.001). Multinomial logistic regression revealed that the factors leading to a significant increase in the risk of poor sleep quality, with consideration to sleep duration, in the population were age, gender, marital status, education, wealth index, physical activity, chronic illness, season, and urban area (p < 0.05). Sleep quality was found to be associated with a higher risk of depression than sleep duration. The findings of this study may be beneficial to healthcare professionals who develop health promotion strategies for reducing the incidence of depression in communities.

Human circadian rhythm studies: Practical guidelines for inclusion/exclusion criteria and protocol

As interest in circadian rhythms and their effects continues to grow, there is an increasing need to perform circadian studies in humans. Although the constant routine is the gold standard for these studies, there are advantages to performing more naturalistic studies. Here, a review of protocols for such studies is provided along with sample inclusion and exclusion criteria. Sleep routines, drug use, shift work, and menstrual cycle are addressed as screening considerations. Regarding protocol, best practices for measuring melatonin, including light settings, posture, exercise, and dietary habits are described. The inclusion/exclusion recommendations and protocol guidelines are intended to reduce confounding variables in studies that do not involve the constant routine. Given practical limitations, a range of recommendations is provided from stringent to lenient. The scientific rationale behind these recommendations is discussed. However, where the science is equivocal, recommendations are based on empirical decisions made in previous studies. While not all of the recommendations listed may be practical in all research settings and with limited potential participants, the goal is to allow investigators to make well informed decisions about their screening procedures and protocol techniques and to improve rigor and reproducibility, in line with the objectives of the National Institutes of Health.

Physical Activity and Executive Functions in Adolescents: The Mediating Role of Sleepiness

(1) Background: Both physical activity and sleepiness were found to influence the development of executive functioning. The present study aimed to address the effects of different levels of physical activity on adolescents' executive performance (i.e., working memory and inhibition), and the role of sleepiness in this relationship. It was hypothesized that a higher level of physical activity would be associated with better executive functioning, while this relationship was mediated (at least partially) by reduced sleepiness at school. (2) Methods: 212 adolescents aged from 10 to 17 were recruited, and they were requested to wear accelerometers for seven consecutive days to measure daily levels of physical activity. The Cleveland Adolescent Sleepiness questionnaire (CASQ) was used to assess sleepiness. The working memory and inhibition control were assessed to indicate executive functioning. (3) Results: It was found that sedentary activity was negatively associated with working memory performance, while light and moderate-to-vigorous physical activities were related to better working memory. The relationship between different levels of physical activity and working memory was mediated by reduced sleepiness at school. (4) Conclusions: Our findings provide nuanced evidence that the benefits of light and moderate-to-vigorous physical activity on cognitive development could be explained by reduced sleepiness at school.

Effects of aerobic versus cognitively demanding exercise interventions on brain structure and function in healthy children-Results from a cluster randomized controlled trial

The beneficial effects of physical activity on neurocognitive functioning in children are considered to be facilitated by physical activity-induced changes in brain structure and functioning. In this study, we examined the effects of two 14-week school-based exercise interventions in healthy children on white matter microstructure and brain activity in resting-state networks (RSNs) and whether changes in white matter microstructure and RSN activity mediate the effects of the exercise interventions on neurocognitive functioning. A total of 93 children were included in this study (51% girls, mean age 9.13 years). The exercise interventions consisted of four physical education lessons per week, focusing on either aerobic or cognitively demanding exercise and were compared with a control group that followed their regular physical education program of two lessons per week. White matter microstructure was assessed using diffusion tensor imaging in combination with tract-based spatial statistics. Independent component analysis was performed on resting-state data to identify RSNs. Furthermore, neurocognitive functioning (information processing and attention, working memory, motor response inhibition, interference control) was assessed by a set of computerized tasks. Results indicated no Group × Time effects on white matter microstructure or RSN activity, indicating no effects of the exercise interventions on these aspects of brain structure and function. Likewise, no Group × Time effects were found for neurocognitive performance. This study indicated that 14-week school-based interventions regarding neither aerobic exercise nor cognitive-demanding exercise interventions influence brain structure and brain function in healthy children. This study was registered in the Netherlands Trial Register (NTR5341).

Development and Validation of Recreational Sport Well-Being Scale

The purpose of this study is to develop the “Recreational Sport Well-being Scale”, which will be used to investigate the subjective recreational sport well-being individuals’ experience after participating in recreational sports. The study participants were Taiwanese who were over 20 years old and participated in recreational sports. Four sets of samples and 4050 questionnaires in total were collected. Using exploratory factor analysis, four factors were extracted from the scale –life satisfaction, physical and mental health, family flourishing, and positive feelings. Confirmatory factor analysis indicated that the scale’s overall goodness of fit, convergent validity, and composite reliability all passed the thresholds. The results of cross-validation indicated that the model passed configural invariance, metric invariance, covariance invariance, and error variance invariance, which suggested that the scale has cross validity. Nomological validity analysis was conducted, showing that Recreational Sport Well-being Scale is nomologically valid since it is positively correlated to Subjective Health Scale. Test-retest reliability analysis suggested that the test results were stable when a retest was carried out two weeks later. The developed “Recreational Sport Well-being Scale” is highly reliable and valid and can be applied to measure future recreational sports participants’ well-being.

Sleep and physical activity: results from a long-term actigraphy study in adolescents

PURPOSE

Research to date suggests that physical activity is associated with improved sleep, but studies have predominantly relied on self-report measures and have not accounted for school day/free day variability. To address these gaps in the literature, the aim of the present study was to (a) quantify physical activity in adolescents using long-term daily actigraphy measurement and (b) to examine the association between actigraphically assessed steps and sleep behavior in a sample of healthy adolescents. To be able to capture intra- and inter-individual differences in the daily physical activity of adolescents, we examined within as well as between subjects effects and its association with sleep.

METHODS

Fifty adolescents between 10 and 14 years of age were included in the present study. In total 5989 days of actigraphy measurement (average of 119 ± 40 days per participant; range = 39-195 days) were analyzed. We use multilevel modeling to disentangle the within and between subject effects of physical activity on sleep. In this way, we examine within an individual, the association between steps during the day and subsequent sleep on a day-to-day basis. On the other hand, our between subjects' analysis allows us to ascertain whether individuals with more overall physical activity have better sleep.

RESULTS

Within a subject more steps on school and free days were associated with later bed times on school and free days as well as later rise times on school days only. On the other hand, comparing between subjects' effects, more steps were associated with lower sleep efficiency on free and school days. No other significant associations were found for the other sleep variables.

CONCLUSION

Our results obtained through objective and long-term measurement of both sleep and number of steps suggest weak or non-significant associations between these measures for most sleep variables. We emphasize the importance of the methodology and the separation of within subject from between subject features when examining the relationship between physical activity and sleep.

Effectiveness of physical activity programs in enhancing sleep outcomes among adolescents: a systematic review

BACKGROUND

Adolescence is a developmental period characterised by rapid physical and psychological changes that heighten the risk for inadequate sleep. Fortunately, physical activity programs (PAPs) are an easy-to-do intervention that has been associated with improved sleep outcomes in different population groups. This systematic review aimed to provide evidence to support the effects of PAPs on sleep outcomes among apparently healthy adolescents.

METHODS

A systematic literature search was performed in online databases of PubMed, Cochrane Library, and PEDro for all dates up to April 2022. All relevant clinical trials reporting on the effects of PAPs on sleep among adolescents were included using a pre-defined inclusion/exclusion criterion (PROSPERO: CRD42020171852). The methodological quality of the included studies was assessed using 'specific checklists per design' (RCTs) provided by the Dutch Cochrane Centre. Qualitative synthesis was used to report the results of the review.

RESULTS

Two RCTs were included and analysed in the review. Both studies were of good methodological quality but lacked blinding. The PAPs in the reviewed studies included mainly aerobic exercises in the form of cross-country running in the mornings, SMS-delivered motivational messages to increase daily step counts, and use of a pedometer and step diaries. Sleep was measured both subjectively by means of sleep questionnaires and objectively using sleep electroencephalographic recordings. Nevertheless, qualitative synthesis is suggestive of an overall positive effect of PAPs on some sleep outcomes in adolescents, albeit with limited to moderate evidence.

CONCLUSION

PAPs appear to have a beneficial effect on some sleep outcomes among apparently healthy adolescents. Nevertheless, the body of evidence is currently scanty, thus warranting the need for more high-quality RCTs.

Sleeping through a Lockdown: How Adolescents and Young Adults Struggle with Lifestyle and Sleep Habits Upheaval during a Pandemic

OBJECTIVES

The objective of the present study was to investigate the relationship between chronotype, lifestyle habits during the pandemic, and changes in sleep timing during the first wave of the COVID-19 pandemic in youth.

METHOD

An online survey of adolescents and young adults (N = 449) was conducted in June 2020. Multivariate hierarchical regressions assessed the contribution of chronotype and changes in lifestyle habits to sleep timing during the COVID-19 pandemic in two age groups (12 to 17 years old and 18 to 25 years old).

RESULTS

Chronotype was a significant predictor of changes in sleep habits during the pandemic in both age groups. In adolescents, electronic device usage during the pandemic was a significant predictor of bedtimes and wake times on weekdays, and caffeine during the pandemic was a predictor of weekday wake times. The number of hours worked during the pandemic was a significant predictor of weekday wake times in both age groups. In young adults, cannabis consumption during the pandemic was a predictor of weekend bedtimes. A later chronotype, along with higher usage of electronic devices, fewer hours worked, as well as higher caffeine and cannabis consumption during the pandemic were associated with delayed sleep timing during the pandemic in youth.

CONCLUSION

These results highlight the importance of assessing lifestyle habits when exploring changes in sleep habits in youth.

Sleep, sedentary behavior, and physical activity in Brazilian adolescents: Achievement recommendations and BMI associations through compositional data analysis

Physical activity, sedentary behavior (SB), and sleep are habitual human behaviors (HHB) which are modifiable throughout the different life phases. Therefore, it is necessary to analyze how the time distribution throughout the day among HHB may be associated with body mass index (BMI). These results could provide inferences which can guide interventions that trigger changes in adolescent behaviors in favor of their health. The objective of this study was to verify the proportion of adolescents who meet the recommendation of sleep, moderate to vigorous physical activity (MVPA), and screen time (ST); to analyze the associations between HHB and BMI, and to determine possible changes in BMI associated with time reallocation between different HHB. Daily HHB recommendations (yes/no) were analyzed by frequency distribution. Compositional data analyses were used to examine the association between HHB and the BMI z-score (zBMI) with covariates (sex, age, and socioeconomic status). Compositional isotemporal substitution models estimated the change in zBMI associated with HHB reallocations from 15 to 120 minutes. A total of 185 adolescents were included (15 to 18 years, 50.8% boys). Thus, total sleep time, SB, light physical activity (LPA) and MVPA were measured by 24-hour accelerometry for seven consecutive days. ST, demographic characteristics, and socioeconomic status were assessed using a questionnaire. Sleep, MVPA, and ST recommendations were achieved by 32.97%, 8.10%, and 1.08% of the sample, respectively. No adolescent was able to achieve all of the daily recommendations. Age was significantly and positively associated with zBMI (p<0.001). Simply replacing 75, 90, and 120 minutes of MVPA by LPA led to an estimated significant increase in zBMI (95CI% z-value, 0.01 to 1.49). The HHB relocation estimates in 24h did not show positive effects on zBMI, nor did it increase the time engaged in MVPA, which may raise the hypothesis that other parameters related to obesity and their related interactions need to be better understood.

Association of physical activity and positive thinking with global sleep quality

This study examined the association of different intensity levels of physical activity and positive thinking with a global sleep quality among college students. The research question was: to what degree were the different intensity levels of physical activity and positive thinking significantly associated with the global sleep quality among college students? We recruited students, who enrolled in regular physical education classes during a fall semester at a major public university. 553 students signed the consent form and indicated their voluntary participation in this study. The final data set for analysis consisted of 403 college students with the mean age of 19.01 years ± 1.559 years (217 males vs. 186 females) based on the results of data screening. They completed three questionnaires: International Physical Activity Questionnaire (IPAQ), Pittsburgh Sleep Quality Index (PSQI), and Positive Thinking Scale (PTS) during a regular physical education class. The multiple regression model revealed that vigorous-intensity physical activity, positive thinking, and negative thinking were collectively and individually associated with the Global PSQI sleep quality (F = 19.389, p = .000), explaining 12.8% of the total variance in the Global PSQI sleep quality for the total sample. College students' engaging in vigorous intensity level of physical activity, and having a good level of positive thinking and a low level of negative thinking were both collectively and individually linked to the Global PSQI sleep quality.

The quality of life of people with ASD through physical activity and sports

Among the factors that influence the quality of life of people with Autism Spectrum Disorder (ASD), physical activity and sport are key dimensions of physical well-being. Few studies take into account the perspectives of people with ASD in order to understand the extent of physical well-being and their subjective perception of it. The development of a system of quality of life indicators related to physical activity and sport for people with ASD and their analysis is the aim of this study, providing guidelines for improvement. A study was carried out with a sample of 276 people, professionals (n = 143), family members (n = 73) and people with ASD (n = 60). The people with ASD in the sample belonged to three age categories: children aged 8-12 years, adolescents aged 12-18 years and adults over 18 years. The research team used a qualitative methodology in the collection of information. They adapted three questionnaires, with validated quality of life scales, to guide the interviews and also applied them in the design of the focus group protocols. Subsequently, the research team analysed the information collected in the focus groups with families and professionals using a DELPHI method. A system for coding the responses and qualitative analysis of the responses was also prepared for the analysis of the data by the research team. Finally, the information obtained was compared with a group of representative experts. The results concluded with the elaboration of a system of quality of life indicators related to the dimension of physical well-being, as well as guidelines and proposals that bring together the perspectives of people with ASD in relation to the practice of sport and physical activity. There is a need to increase the practice of sport among people with ASD in order to promote their health, social participation and personal satisfaction. It is concluded that it is not possible to obtain a broad picture of the quality of life of people with ASD and their families due to lack of information. However, the method and the results obtained represent a first approach at national level to increase knowledge about the quality of life of people with ASD.

The Impact of COVID-19 on the Lifestyles of University Students: A Spanish Online Survey

The present study aimed to investigate the perceived changes in lifestyle behaviors among Spanish university students during COVID-19-related confinement. An observational, descriptive, and cross-sectional survey study was conducted during April 2020. Sociodemographic and anthropometric data were then obtained. The FANTASTIC questionnaire was used to assess the lifestyles of the 488 participants who took part in the study. Of the participants, 76.3% were female. Overall, the lifestyles of university students significantly deteriorated during the period of confinement caused by the COVID-19 pandemic in Spain. University female students were especially affected compared to their male fellows (p = 0.010). For women, social and family relationships (p < 0.001), personality (p < 0.001), interior (p < 0.001), and career (p < 0.001) were the aspects that worsened during confinement. For men, lack of physical exercise (p < 0.001), social and family relationships (p < 0.001), and career (p = 0.002) were affected to a greater extent. In both cases, confinement was a protective factor against the consumption of tobacco, toxins (p < 0.001), and alcohol (p < 0.001). Gender (p = 0.008) and obesity (p = 0.044) were the two factors that most affected the change in the score of the FANTASTIC questionnaire. Spanish university students’ lifestyles worsened during the lockdown caused by the COVID-19 pandemic, especially those of women, who were the most affected. Some aspects, such as those related to social and emotional behaviors, were deeply affected, while confinement could be a protective factor against previous toxic habits.

Sex differences in childhood sleep and health implications

CONTEXT

Sleep is critical for optimal childhood metabolic health and neurodevelopment. However, there is limited knowledge regarding childhood sex differences in sleep, including children with neurodevelopmental disorders, and the impact of such differences on metabolic health.

OBJECTIVE

To evaluate if sex differences in childhood sleep exist and if sleep associates with metabolic health outcomes equally by sex. Using autism spectrum disorder (ASD) as a case study, we also examine sleep sex differences in children with a neurodevelopmental disorder.

METHODS

A narrative review explored the literature focussing on sex differences in childhood sleep.

RESULTS

Sex differences in sleep were not detected among pre-adolescents. However, female adolescents were more likely to report impaired sleep than males. Childhood obesity is more common in males. Shorter sleep duration may be associated with obesity in male pre-adolescents/adolescents; although findings are mixed. ASD is male-predominant; yet, there was an indication that pre-adolescent female children with ASD had more impaired sleep.

CONCLUSION

Sex differences in sleep appear to emerge in adolescence with more impaired sleep in females. This trend was also observed among pre-adolescent female children with ASD. Further research is needed on sex differences in childhood sleep and metabolic health and the underlying mechanisms driving these differences.

Football and Zumba Training in Female Hospital Staff: Effects after 12 and 40 Weeks on Self-Reported Health Status, Emotional Wellbeing, General Self-Efficacy and Sleep Problems

Background: This 40-weeks intervention study evaluates the effects on self-reported health status, emotional wellbeing, general self-efficacy and sleep problems among female hospital employees. Methods: 107 employees were cluster-randomized into three groups; football (FG), Zumba (ZG) and control (CG). Outcome measurements were conducted at baseline, 12 and 40 weeks. Weekly training frequencies in the first 12 and next 28 weeks were 2.4 ± 0.3 and 0.8 ± 0.2 in FG and 2.3 ± 0.3 and 0.9 ± 0.2 in ZG. Results: Compared to the CG, the ZG showed significant improvement in self-reported health status (p = 0.025), a reduced frequency of poor and restless sleep (on a 0–4 scale) (p = 0.004), as well as a tendency for reduction in the frequency of problems falling asleep (p = 0.055) and overall sleep problems (p = 0.051). Between baseline and 12 weeks, both the FG (p = 0.017) and the ZG (p = 0.017) showed within-group improvements in emotional wellbeing, whereas this improvement was maintained only in the ZG between baseline and 40 weeks (p = 0.002). The FG showed a significant within-group improvement in general self-efficacy (p = 0.012) between baseline and 12 weeks follow-up, with no such improvements in the other groups. Conclusion: The present findings revealed that a physical activity intervention with Zumba as well as football training may improve mental health and sleep outcomes in female hospital staff.

Problematic internet use and subjective sleep quality among college students in China: Results from a pilot study

Objective poor subjective sleep quality (SSQ) and problematic Internet use (PIU) were common among college students in China, but their prevalence and interconnections were understudied. Participants: 1040 college students (60.0% females), ranging in age from 16 to 26 (mean = 20.32; SD = 1.43). Methods: Participants completed a survey assessing their SSQ, PIU, and other covariates. Multivariate logistic regression analyses were conducted to test association between SSQ and PIU. Results: Around 46.8% of the sample reported poor SSQ, 17.3% was diagnosed with Internet addiction, and 64.3% were Internet overusers. Poor sleepers had 2.03 times greater odds (95%CI: 1.41-2.91) of being Internet overusers, and 3.25 greater odds (95%CI: 2.05-5.17) of being Internet addicts. Conclusions: Poor SSQ was strongly associated with elevated odds of PIU over and above the contributions of poor psychological functioning, substance use, and physical activity. Programs aimed at enhancing SSQ among college students should take reducing PIU into perspective.

Physical Activity and Executive Function in Children With ADHD: The Mediating Role of Sleep

This study examined the mediating role of sleep in the relationship between physical activity and executive function in children with attention deficit hyperactivity disorder (ADHD). Fifty-six children with ADHD were recruited from Shenzhen Children's Hospital. Participants wore an accelerometer for seven consecutive days to measure physical activity and sleep quality. Activity counts were analyzed to measure moderate-to-vigorous physical activity (MVPA). Four sleep parameters, including sleep latency (SL), sleep efficiency, total sleep time, and wake after sleep onset were recorded from the actigraph. Three core executive functions, inhibitory control; working memory (WM); and cognitive flexibility (CF), were assessed from computer-based tasks: the flanker task, and the Tower of London and Trail Making Tests, respectively. The regression results showed that MVPA was negatively associated with SL (-0.169; 95%CI [-0.244, -0.112]). WM (total scores) was positively related to MVPA (0.028, 95%CI [0.008, 0.048]), but negatively related to SL (-0.105, 95%CI [-0.167, -0.030]). CF (part B errors) was negatively associated with MVPA (-0.031, 95%CI [-0.055, -0.005]) and positively correlated with SL (0.184, 95%CI [0.092, -0.260]). The indirect effect of SL was found for MVPA and WM (0.018, 95%CI [0.015, 0.034]), supporting the indirect partial mediation. Similarly, the indirect effect of SL was found between MVPA and CF (-0.031, 95%CI [-0.060, -0.012]), supporting the indirect partial mediation. The mediating role of SL in children with ADHD suggests that the intensity of physical activity plays a key role in linking sleep quality and executive function in this group.

Sufficient sleep duration in autistic children and the role of physical activity

LAY ABSTRACT

Higher levels of physical activity may be associated with improved sleep in children, but this relationship is still being determined, especially in autistic children. In this study, we used existing data from the 2018 National Survey of Children's Health. Caregivers of children 6-17 years old, including caregivers of autistic children, completed a questionnaire that included questions about physical activity (days active in the past week) and sleep duration. We then determined if children were obtaining the recommended hours of sleep for their age (i.e. sufficient sleep). We found that higher physical activity levels were associated with sufficient sleep duration, but this finding was weaker in autistic children. In particular, this association was not observed in autistic children with more severe autism spectrum disorder, female autistic children, and autistic children 6-12 years old. In conclusion, physical activity is a promising approach to help children obtain sufficient sleep duration. However, more personalized approaches to improving sleep may be needed for certain groups of autistic children.

Physical Activity, Fitness, and Executive Functions in Youth: Effects, Moderators, and Mechanisms

Over the last decade, a growing body of research has examined the link between physical activity, fitness, and cognitive function in children and adolescents. Physical activity experimental research conducted with children and adolescents has identified selectively greater effects for tasks requiring higher order executive functions. As such, the primary aim of our chapter is to provide an overview of findings from systematic reviews and meta-analyses that have examined the effects of physical activity on measures of executive function in child and adolescent populations. We begin our chapter with definitions of key concepts associated with physical activity, fitness and cognitive function. We then provide a synthesis of systematic reviews and meta-analyses that have examined the acute and chronic effect of physical activity on EFs. Following this, we discuss the quantitative (e.g., time, intensity) and qualitative (e.g., type) characteristics of physical activity that may moderate effects. The next section focuses on the neurobiological, psychosocial and behavioral mechanisms responsible for the effect of physical activity on executive functions. We conclude by highlighting the limitations of the existing evidence base and providing recommendations for future research.

When Much Is Too Much-Compared to Light Exercisers, Heavy Exercisers Report More Mental Health Issues and Stress, but Less Sleep Complaints

BACKGROUND

Physical inactivity has become a global somatic and mental health issue. To counterbalance, promoting regular physical activity appears plausible, above all among adults, where physical inactivity is particularly high. However, some, but sparse, research also indicates that excessive exercising might be associated with unfavorable mental health dimensions. Here, we tested the hypothesis that excessive exercising was associated with more mental health issues. To this end, we assessed mental health issues, stress, mental toughness, and sleep disturbances among heavy and light adult exercisers.

METHODS

A total of 200 adults (mean age: 35 years; 62% females) took part in the study. Of those, 100 were heavy exercisers (18-22 h/week), and 100 were light exercisers (1-6 h/week). Participants completed questionnaires covering sociodemographic information, mental health issues, perceived stress, mental toughness, and sleep disturbances.

RESULTS

Compared with light exercisers, heavy exercisers reported higher mental health issues, more stress, but also higher mental toughness scores and less sleep disturbances. Higher age, lower mental toughness scores, heavy exerciser-status, and more sleep disturbances predicted higher mental health complaints.

CONCLUSIONS

Compared with light exercising, heavy exercising might be associated with more mental health issues. As such, it appears that the association between exercise frequency, intensity, and duration and psychological well-being might be related to an optimum point, but not to a maximum point. In a similar vein, heavily exercising athletes, their coaches, parents, and representatives of sports associations should get sensitized to possible adverse psychological effects of excessive physical activity patterns.

Association between Physical Activity and Sleep Difficulties among Adolescents in Germany: The Role of Socioeconomic Status

We examined sleep difficulties among adolescents in Germany and the association with physical activity (PA). Furthermore, we analyzed whether the association varied with the socioeconomic status (SES) among adolescent girls and boys in Germany. Using data from the German Health Interview Examination Survey for Children and Adolescents (KiGGS) study (Wave 2), 6599 adolescents aged 11 to 17 years were included in the analyses. We conducted sex-stratified logistic regression analyses. Dependent variables were unrecommended sleep duration (defined as a duration of sleep that does not meet the recommended duration), sleep-onset difficulties, trouble sleeping, and daytime sleepiness. Most adolescent girls and boys reported sleep difficulties. While no associations between PA and sleep difficulties were observed, a significant interaction between PA and SES was found for sleep duration in boys and daytime sleepiness in girls. Thus, adolescents with low SES had fewer sleep difficulties if they met the recommendation for PA, compared with those in other SES groups. In Germany, a large proportion of adolescents have sleep difficulties. We found that the experience of sleep difficulties varied according to PA, sex, and the family SES. Future sleep promotion programs should consider these differences.

White Matter Integrity Underlies the Physical-Cognitive Correlations in Subjective Cognitive Decline

Objective: Although previous studies postulated that physical and cognitive decline codeveloped in preclinical dementia, the interconnected relationship among subjective cognitive complaints (SCCs), objective cognitive performance, and physical activity remained hazy. We investigated the mediating roles of physical activity between subjective and objective cognition. Diffusion tensor imaging (DTI) was utilized to test our hypothesis that brain white matter microstructural changes underlie the physical-cognitive decline in subjective cognitive decline (SCD).

Methods: We enrolled cognitively normal older adults aged > 50 years in the Community Medicine Research Center of Keelung Chang Gung Memorial Hospital during 2017–2020. Regression models analyzed mediation effects of physical activity between subjective and objective cognition. The self-reported AD8 questionnaire assessed SCCs. The SCD group, defined by AD8 score ≥ 2, further underwent diffusion MRI scans. Those who agreed to record actigraphy also wore the SOMNOwatch™ for 72 h. Spearman's correlation coefficients evaluated the associations of diffusion indices with physical activity and cognitive performance.

Results: In 95 cognitively normal older adults, the AD8 score and the Montreal Cognitive Assessment (MoCA) score were mediated partially by the metabolic equivalent of the International Physical Activity Questionnaire-Short Form (IPAQ-SF MET) and fully by the sarcopenia score SARC-F. That is, the relation between SCCs and poorer cognitive performance was mediated by physical inactivity. The DTI analysis of 31 SCD participants found that the MoCA score correlated with mean diffusivity at bilateral inferior cerebellar peduncles and the pyramids segment of right corticospinal tract [p < 0.05, false discovery rate (FDR) corrected]. The IPAQ-SF MET was associated with fractional anisotropy (FA) at the right posterior corona radiata (PCR) (p < 0.05, FDR corrected). In 15 SCD participants who completed actigraphy recording, the patterns of physical activity in terms of intradaily variability and interdaily stability highly correlated with FA of bilateral PCR and left superior corona radiata (p < 0.05, FDR corrected).

Conclusions: This study addressed the role of physical activity in preclinical dementia. Physical inactivity mediated the relation between higher SCCs and poorer cognitive performance. The degeneration of specific white matter tracts underlay the co-development process of physical-cognitive decline in SCD.

The role of anxiety and depression in the relationship between physical activity and sleep quality: A serial multiple mediation model

BACKGROUND

Physical inactivity exacerbates poorer sleep quality, but potential underlying mechanisms of this association remain unknown. The present study aims to disentangle the pathways linking psychical activity to sleep quality through the serial mediation effect of anxiety and depression in a Chinese population.

METHODS

Data analyzed were from Guangdong Sleep and Psychosomatic Health Survey, a cross-sectional population-based study with a representative sample of adult inhabitants aged 18-85 years living in Guangdong province, China. A total of 13,768 participants were included with the response rate of 80.4%. Singe and serial mediation analyses were conducted to examine whether anxiety and depression mediated the relationship between physical activity and sleep quality, independently and jointly.

RESULTS

Both direct and indirect effects of physical activity on sleep quality were found. As predicted, anxiety and depression mediated the relationship between physical activity and sleep quality (B _Anxiety = -0.17, 95% bootstrap CI: -0.20 to -0.15; B _Depression= -0.25, 95% bootstrap CI: -0.28 to -0.21), respectively. In addition, serial mediation analyses indicated that the association of physical activity and sleep quality is mediated by anxiety and depression in a sequential manner (B = -0.13, 95% bootstrap CI: -0.15 to -0.11).

LIMITATIONS

The primary limitation of the study is the cross-sectional design, which limits the causal inference ability.

CONCLUSIONS

These findings highlight the role of anxiety and depression as serial mediators of the relationship between physical activity and sleep quality. Thus, exercise-based programs focusing on improving sleep could benefit from a multi-faceted approach therapeutically targeting psychiatric disorders.

Influence of excessive daily sleeping and sleep quality on BDNF and NGF serum levels in adolescents

INTRODUCTION

The brain-derived neurotrophic factor (BDNF) and neural growth factor (NGF) are widely expressed in the brain and play an important role in neuroplasticity, neurogenesis, and increased neuronal connections. Previous studies have shown that reduced serum levels of these proteins are associated with disorders in human sleep.

OBJECTIVE

Current study evaluates the prevalence in adolescents of excessive daytime sleepiness (EDS) and sleep quality, and analyzes the influence of these factors on BDNF and NGF serum levels.

METHODS

A cross-section population-based study was conducted with data from a Brazilian birth cohort, with a sample of five hundred and thirteen 18-19-year-old adolescents. Sleep quality was assessed by the Pittsburgh Sleep Quality Index and EDS by Epworth Sleepiness Scale. Neurotrophins serum levels were measured by Luminex™ technology kits. Analysis consisted of marginal structural models which compared people who were exposed and not exposed to sleep quality and EDS.

RESULTS

Poor sleep quality and EDS were detected in 62.57% and 36.35% of the sample. Adolescents with poor sleep quality and EDS had -0.39 (p-value = 0.049) and -0.51 pg/ml in NGF (p-value = 0.009). Individuals with self-reported sleep disorder had lower serum levels of NGF (Coef. -0.41, p-value = 0.045).

CONCLUSION

High prevalence of EDS and low sleep quality in a population of adolescents were evidenced. Poor sleep quality and EDS were associated with lower NGF levels, whilst adolescents with self-reported sleep disorder had lower serum levels of NGF.

Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II

BACKGROUND

Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals.

OBJECTIVE

By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue.

METHODS

Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models.

RESULTS

Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020.

CONCLUSIONS

In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic.

Physical Activity and Inhibitory Control: The Mediating Role of Sleep Quality and Sleep Efficiency

Objectives: the current study aimed to investigate the relationship between physical activity (PA) level and inhibitory control performance and then to determine whether this association was mediated by multiple sleep parameters (i.e., subjective sleep quality, sleep duration, sleep efficiency, and sleep disturbance). Methods: 180 healthy university students (age: 20.15 ± 1.92 years) from the East China Normal University were recruited for the present study. PA level, sleep parameters, and inhibitory control performance were assessed using the International Physical Activity Questionnaire (IPAQ), the Pittsburgh Sleep Quality Index Scale (PSQI), and a Stroop test, respectively. The data were analyzed using structural equation modeling. Results: A higher level of PA was linked to better cognitive performance. Furthermore, higher subjective sleep quality and sleep efficiency were associated with better inhibitory control performance. The mediation analysis revealed that subjective sleep quality and sleep efficiency mediated the relationship between PA level and inhibitory control performance. Conclusion: our results are in accordance with the literature and buttress the idea that a healthy lifestyle that involves a relatively high level of regular PA and adequate sleep patterns is beneficial for cognition (e.g., inhibitory control performance). Furthermore, our study adds to the literature that sleep quality and sleep efficiency mediates the relationship between PA and inhibitory control performance, expanding our knowledge in the field of exercise cognition.

Compared to Individuals with Mild to Moderate Obstructive Sleep Apnea (OSA), Individuals with Severe OSA Had Higher BMI and Respiratory-Disturbance Scores

Objective: Individuals with obstructive sleep apnea (OSA) are at increased risk to suffer from further somatic and sleep-related complaints. To assess OSA, demographic, anthropometric, and subjective/objective sleep parameters are taken into consideration, but often separately. Here, we entered demographic, anthropometric, subjective, and objective sleep- and breathing-related dimensions in one model. Methods: We reviewed the demographic, anthropometric, subjective and objective sleep- and breathing-related data, and polysomnographic records of 251 individuals with diagnosed OSA. OSA was considered as a continuous and as categorical variable (mild, moderate, and severe OSA). A series of correlational computations, X²-tests, F-tests, and a multiple regression model were performed to investigate which demographic, anthropometric, and subjective and objective sleep dimensions were associated with and predicted dimensions of OSA. Results: Higher apnea/hypopnea index (AHI) scores were associated with higher BMI, higher daytime sleepiness, a higher respiratory disturbance index, and higher snoring. Compared to individuals with mild to moderate OSA, individuals with severe OSA had a higher BMI, a higher respiratory disturbance index (RDI) and a higher snoring index, while subjective sleep quality and daytime sleepiness did not differ. Results from the multiple regression analysis showed that an objectively shorter sleep duration, more N2 sleep, and a higher RDI predicted AHI scores. Conclusion: The pattern of results suggests that blending demographic, anthropometric, and subjective/objective sleep- and breathing-related data enabled more effective discrimination of individuals at higher risk for OSA. The results are of practical and clinical importance: demographic, anthropometric, and breathing-related issues derived from self-rating scales provide a quick and reliable identification of individuals at risk of OSA; objective assessments provide further certainty and reliability.

A Study on the Relationship Between Physical Activity, Sedentary Behavior, and Sleep Duration in Preschool Children

Purpose: Explore the role of physical activity (PA) and sedentary behavior (SB) in the sleep of preschool children.

Method: Preschool children (n = 458) from kindergarten were recruited, measures included accelerometer-derived 24 h activity [SB, light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), daytime sleep duration (DSP), and nocturnal sleep duration (NSP)]. A self-made questionnaire was used to supplementary survey on different types of SB. The two-layer chi-square test and the Cochran–Mantel–Haenszel test were used and significance set at p < 0.05.

Results: PA is mainly a protective factor for DSP, while SB is mainly a risk factor for NSP of preschool children; Screen-type SB including screen viewing SB and video game SB is a risk factor for NSP, while quiet learning SB have no significant correlation with sleep duration in preschool children; Gender and social economic status are important factors affecting the association of PA, SB, and sleep duration in preschool children.

Conclusions: The relationship between sleep duration at different periods and PA and SB of preschool children is different. Future educators need to gradually realize the different factors affecting the sleep of preschool children at different stages, clarify the protective factors and risk factors, in order to improve the sleep duration of preschool children.

Nurses' physical activity exploratory study: Caring for you so you can care for others

BACKGROUND

Nurses report the greatest stress of all health care workers. Although physical activity (PA) is associated with health benefits among other populations, nurses have stressors that other occupations do not typically encounter. It is important for nurses to identify techniques for stress management since stressors negatively impact their health and patient care.

OBJECTIVE

We aimed to examine the relationship between PA levels and physical, mental, and occupational health among nurses.

METHODS

Nurses (N = 62) completed measures of anthropometrics, demographics, and domains of physical, mental, and occupational health. Pearson correlations determined the relationship between PA and measures health along with the relationship between PA and health among active versus inactive nurses.

RESULTS

Fatigue was significantly correlated with moderate-to-vigorous PA (r = -0.27, p < 0.05). Relationships were found between mental health and light and moderate intensity PA (r = 0.40, p < 0.001; r = 0.30, p < 0.05).

CONCLUSIONS

Stress is prevalent among nurses and negatively impacts a nurse's health along with patient care. Findings suggest health benefits associated with PA among nurses. PA interventions among nurses may be needed to fully see the effects of PA on physical, mental, and occupational health, and ultimately patient health and safety.

Sleep and health-related physical fitness in children and adolescents: a systematic review

OBJECTIVES

The aim of this systematic review was to summarize the evidence on the associations between the sleep duration or sleep quality and cardiorespiratory and muscular fitness in children and adolescents aged 6-19 years.

MATERIAL AND METHODS

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta- analyses (PRISMA) and was registered with the international prospective register of systematic reviews PROSPERO network. Three databases (PubMed, SPORTDiscus and Science Direct) were searched until October 2019 for scientific articles concerning sleep duration, sleep quality and physical fitness.

RESULTS

Six articles, including 5797 participants, from 11 different countries, were included in the current systematic review.

CONCLUSION

Longer periods of sleep and better sleep quality were associated with higher levels of physical fitness.

Which objective sleep elements predict children's perceptions of good sleep quality? A preliminary investigation based on polysomnography and actigraphy

OBJECTIVES

Objective sleep elements that underlie child ratings of sleep quality are largely unknown. Child-based sleep recommendations, therefore, typically focus on duration. An expert panel recently provided specific recommendations regarding objective sleep parameters that correspond with higher quality sleep, but child-based studies from which to draw conclusions were notably limited. The present study used actigraphy and polysomnography to explore sleep continuity and architectural variables that correspond with higher ratings of sleep quality in a sample of school-aged children.

METHODS

Fifty-two healthy, prepubertal children (aged 7-11 years) completed one night of unattended ambulatory polysomnography at home with concurrent actigraphy and provided sleep quality ratings the following morning. Associations between sleep variables and subjective ratings were examined using polynomial regression models to examine potential linear and nonlinear relationships.

RESULTS

In contrast to findings among adults, total sleep time, sleep onset latency, and sleep efficiency values were unrelated to child ratings of sleep quality. Wake after sleep onset (WASO) showed a curvilinear (reversed j-shaped) relationship such that perceptions of sleep quality were high when WASO values were less than approximately 30 minutes. For sleep architecture, N1% showed a significant quadratic association with sleep quality such that N1% between 2% and 6% corresponded with high sleep quality ratings.

CONCLUSIONS

Our findings support expert recommendations regarding WASO values that predict high quality sleep in children, but also await replication. There is need for additional research aimed at understanding objective sleep elements and other influences of children's perceptions of sleep quality using linear and nonlinear models.

Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents

Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15–17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS ≥ 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (≤1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.

Self-Esteem and Symptoms of Eating-Disordered Behavior Among Female Adolescents

BACKGROUND

Compared to males, female adolescents show greater concerns about their appearance, concerns related to their self-esteem. We explored the associations between self-esteem, body image and BMI as proxies for appearance, and eating-disordered behavior among adolescent females.

METHODS

A total of 263 females (mean age:15.78 years) took part in this study. They completed questionnaires covering anthropometric characteristics, self-esteem, eating-disordered behavior, subjective physical activity levels, and body image.

RESULTS

Higher scores for self-esteem were associated with higher scores for eating-disordered behavior, indices of physical activity, and slimmer body image. Body image was not associated with eating-disordered behavior. Multiple regression analyses showed that self-esteem, but not physical activity, or body image predicted eating-disordered behavior.

CONCLUSIONS

Among a non-clinical sample of female adolescents, self-esteem and eating-disordered behavior were positively associated. Body image was associated in a complex and contradictory fashion. It is possible that cognitive-emotional mastering of the vital impulse to eat may enhance self-esteem.